NPIMap

Organization Active NPI

Wisconsin Dental Group, S.C.

Doing business as ForwardDental Menomonee Falls

  • Pediatric Dentistry
  • Menomonee Falls, WI
National Provider Identifier
1578693149
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
WISCONSIN DENTAL GROUP, S.C.
Doing business as
ForwardDental Menomonee Falls
Practice address
N80W17707 Custer LN
Menomonee Falls, WI 53051-3630
Phone
(262) 524-9893
Fax
(262) 524-9225
NPI assigned
Mar 6, 2007
Last updated
Mar 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
WISCONSIN DENTAL GROUP, S.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Celia Hayes
Title
Credentialing Coordinator
Phone
(217) 540-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

N80W17707 Custer LN
Menomonee Falls, WI 53051-3630

Mailing address

N80W17707 Custer LN
Menomonee Falls, WI 53051-3630
Phone (262) 524-9893

Other names 1

  • ForwardDental Menomonee Falls Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wisconsin Dental Groupsc32 organizations share this tax ID, including this one
Part of
Wisconsin Dental Groupsc

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

N80W17707 Custer Ln
Menomonee Falls, WI 53051
Phone (262) 255-2727

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1578693149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N80W17707 CUSTER LN",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530513630",
            "telephone_number": "262-524-9893",
            "fax_number": "262-524-9225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N80W17707 CUSTER LN",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530513630",
            "telephone_number": "262-524-9893",
            "fax_number": "262-524-9225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN DENTAL GROUP, S.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WISCONSIN DENTAL GROUP, S.C.",
        "enumeration_date": "2007-03-06",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ForwardDental Menomonee Falls",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Menomonee Falls, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.